Diminished concentrations of insulin-like growth factor I in cystic fibrosis

Cystic fibrosis is frequently accompanied by a catabolic condition with low body mass index caused by a number of disease complications. Insulin-like growth factor-I (IGF-I) is an anabolic hormone and an important marker of nutritional status, liver function, and linear growth. Available data on IGF-I in cystic fibrosis are sparse and conflicting. From 1990-3, 235 of our 240 patients (114 males, 121 females, median age 16.2 years, ranged 0.1-44.0 years) had IGF-I measured once by radioimmunoassay. IGF-I was significantly reduced compared with a healthy Scandinavian control population: mean (-2 SD to +2 SD) IGF-I SD score was -0.97 (-3.7 to 1.7) in males and -0.67 (-3.2 to 1.9) in females. Height SD score was -0.95 (-3.3 to 1.4) in males and -0.81 (-3.2 to 1.6) in females. In patients who were still in the growth period a significant correlation of IGF-I SD score to height SD score (r = 0.28, p < 0.001) was found. The low IGF-I concentrations may reflect the catabolic state of many patients with cystic fibrosis and play a part in their abnormal growth pattern.     

Less severe retinopathy of prematurity induced by surfactant replacement therapy

To assess the effect of surfactant replacement therapy (SRT) on the prevalence and severity of retinopathy of prematurity (ROP), we compared data from 160 SRT-treated preterm infants with data from 230 historic controls. The prevalence of ROP was 30.6% in the treatment group and 23.4% in the control group. Severe ROP (stages 3-4) was seen in 6.1% of the infants with ROP in the treatment group and 20.3% of the ROP patients in the control group. Surfactant therapy had no influence on the prevalence of ROP (odds ratio 1.4, 95% confidence interval 0.797-2.459, p = 0.242). However, SRT was associated with a decreased risk for severe ROP, compared to mild ROP (odds ratio 0.226, 95% confidence interval 0.056-0.905, p = 0.036). These data suggest that SRT is associated with a decreased risk for severe ROP.     

Hepatic and cardiac necrosis in a patient with prostatic carcinoma given ε-aminocaproic acid

The pathological findings in a case of prostatic carcinoma with fibrinolysin, treated with ε-aminocaproic acid, included hepatic and cardiac necrosis. The possibility is discussed that the latter lesions may be a complication of ε-aminocaproic acid therapy or produced by the proteolytic action of the fibrinolysin.     

Volumetric rendering of MR images

The authors developed new techniques for three-dimensional display of magnetic resonance (MR) images that preserve soft-tissue definition, are fully automatic, and work with routinely used section thicknesses. MR images are segmented, selectively enhanced, and displayed by means of a volumetric rendering algorithm. These techniques were used to illustrate normal anatomy of the brain, knee, and liver. Three-dimensional rendering of balanced spin-echo images shows the ventricles and extracerebral veins and of T1-weighted images, the sulci and gyri. The large hepatic and portal vessels can be seen with these enhancement techniques. Three-dimensional views of the knee reveal articular surfaces of the tibia and clearly depict menisci and posterior and anterior cruciate ligaments. These techniques make it possible to image multiple soft tissues simultaneously while preserving the detail contained in the original images. Three-dimensional presentation of complex, overlapping anatomic regions is helpful in surgical planning and should lead to improved diagnosis.     

003 胺碘酮可作为心房纤颤转复为窦性心律的首选药物

在美国，胺碘酮仅被批准用于治疗致命性室性心律失常，而在其他国家，尤其是南欧，也被广泛用于心房纤颤(Af)的治疗。然而有关胺碘酮复律效果报道不一，其成功率在16％～92％。本文前瞻性随机对照研究胺碘酮作为Af复律的首选药物的疗效及安全性。 连续208例症状性Af，男性102例，女性106例，年龄27～78(65±10)岁。将受试者随机分为胺碘酮治疗组与安慰剂组。胺碘酮用法：300mg静脉注射，持续1小时，然后以20mg/kg静脉滴注，持续24小时，继之口服200mg，tid，共1周，400mg/d共3周。如果受试者此前未用地高辛，则给予地高辛0.5mg静脉注射，2小时后再静脉注射0.25mg，继之静脉注射0.25mg，q6h，共24小时，此后调整地高辛剂量以维持治疗剂量的血清浓度，对Af持续48小时以上或持续时间不明、未用抗凝药物者均应用醋硝香豆素(acenocoumaro1)，至少21天，复律成功者继续用药21天，未成功者用药时间不定。本研究将Af持续1个月以上者定义为慢性Af，＜24小时者定义为新近发作Af，其余定义为持续性Af。     

A near-fatal reaction during granulocyte transfusion of a neonate

Although reactions to granulocyte transfusions in neonates are rarely reported, we observed a near-fatal pulmonary reaction, presumably due to white cell antibodies, in a neonate with Rh hemolytic disease. The hemolytic disease was being treated with exchange transfusions, and at 2 days after the infant's birth, bacterial sepsis was suspected and granulocyte transfusions were begun. The first granulocyte transfusion (Day 3) was uneventful. Five minutes after the beginning of the second granulocyte transfusion (Day 4), severe respiratory distress, hypotension, bradycardia, cyanosis, and acidosis suddenly occurred. The infant's serum obtained after the reaction contained granulocytotoxic and B-lymphocytotoxic antibodies that reacted with leukocytes from the second granulocyte donor. Antibodies could not be detected either in the initial infant serum or in maternal serum. However, an antileukocyte antibody was present in the serum of a parous woman donor. We used plasma from this woman to prepare reconstituted whole blood for the exchange transfusion that we performed immediately preceding the second granulocyte transfusion. Despite the sequence of events, an irrefutable cause-and-effect mechanism could not be established because the properties of the donor and neonatal antibodies were similar, but not identical. However, this catastrophic event emphasizes both the potential for adverse effects of granulocyte transfusions in neonates and the need for caution when transfusing blood from parous women.     

Anesthesia for children in Sub-Saharan Africa – a description of settings, common presenting conditions, techniques and outcomes

Anesthesia in developing countries deserves special attention. The most common technique is general anesthesia (with spontaneous or manually assisted ventilation). Nonmedical anesthetists with limited training and supervision and lacking the most common drugs and anesthetic equipment administer anesthesia, usually for emergency surgery. There are important safety issues, especially for pediatric anesthesia. Regarding pediatric surgery, the major workload is due to abdominal emergencies, mainly neonatal bowel obstruction or peritonitis due to typhoid perforation. The morbidity and mortality rate for these conditions is high.